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头孢洛扎/他唑巴坦治疗革兰氏阴性菌感染的疗效和安全性:临床研究的系统评价和荟萃分析

The efficacy and safety of ceftolozane-tazobactam in the treatment of GNB infections: a systematic review and meta-analysis of clinical studies.

作者信息

Chi Yulong, Xu Juan, Bai Nan, Liang Beibei, Cai Yun

机构信息

Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing, China.

Graduate School of Chinese PLA General Hospital, Beijing, China.

出版信息

Expert Rev Anti Infect Ther. 2023 Feb;21(2):189-201. doi: 10.1080/14787210.2023.2166931. Epub 2023 Jan 19.

Abstract

BACKGROUND

Ceftolozane-tazobactam is a novel cephalosporin/β-lactamase inhibitor combination with activity against Gram-negative bacteria (GNB). We aimed to comprehensively evaluate the clinical efficacy and safety of ceftolozane-tazobactam in treating GNB infections in adult patients.

RESEARCH DESIGN AND METHODS

PubMed, Embase, and Cochrane databases were retrieved until August 2022. Randomized trials and non-randomized controlled studies evaluating ceftolozane-tazobactam and its comparators in adult patients with GNB infections were included.

RESULTS

A total of 13 studies were included. Overall, patients receiving ceftolozane-tazobactam had significant advantages in clinical cure (odds ratio [OR], 1.62; 95% CI, 1.05-2.51) and microbiological eradication (OR, 1.43; 95% CI, 1.19-1.71), especially in -infected patients. Ceftolozane-tazobactam had a significant advantage in clinical success or microbial eradication compared with polymyxin/aminoglycosides (PL/AG) or levofloxacin. There were no significant differences in adverse events (AEs), infection (CDI), and mortality between ceftolozane-tazobactam and comparators. Notably, ceftolozane-tazobactam showed a significantly lower risk of acute kidney injury compared with PL/AG.

CONCLUSIONS

Ceftolozane-tazobactam showed excellent clinical and microbiological efficacy in treating GNB, especially -induced infections. The overall safety profile of ceftolozane-tazobactam was comparable to other antimicrobials, with no increased risk of CDI and obvious advantage over antibacterial agents with high nephrotoxicity.

摘要

背景

头孢洛扎/他唑巴坦是一种新型头孢菌素/β-内酰胺酶抑制剂组合,对革兰氏阴性菌(GNB)具有活性。我们旨在全面评估头孢洛扎/他唑巴坦治疗成年患者GNB感染的临床疗效和安全性。

研究设计与方法

检索PubMed、Embase和Cochrane数据库至2022年8月。纳入评估头孢洛扎/他唑巴坦及其对照药物治疗成年GNB感染患者的随机试验和非随机对照研究。

结果

共纳入13项研究。总体而言,接受头孢洛扎/他唑巴坦治疗的患者在临床治愈(优势比[OR],1.62;95%置信区间[CI],1.05 - 2.51)和微生物清除(OR,1.43;95%CI,1.19 - 1.71)方面具有显著优势,尤其是在[具体感染类型未明确]感染患者中。与多粘菌素/氨基糖苷类药物(PL/AG)或左氧氟沙星相比,头孢洛扎/他唑巴坦在临床成功或微生物清除方面具有显著优势。头孢洛扎/他唑巴坦与对照药物在不良事件(AE)、艰难梭菌感染(CDI)和死亡率方面无显著差异。值得注意的是,与PL/AG相比,头孢洛扎/他唑巴坦发生急性肾损伤的风险显著更低。

结论

头孢洛扎/他唑巴坦在治疗GNB感染,尤其是[具体感染类型未明确]诱导的感染方面显示出优异的临床和微生物学疗效。头孢洛扎/他唑巴坦的总体安全性与其他抗菌药物相当,无CDI风险增加,且相对于具有高肾毒性的抗菌药物具有明显优势。

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